Healthcare Provider Details

I. General information

NPI: 1861942203
Provider Name (Legal Business Name): PEGGY SCOTT RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W CENTRAL PARK AVE
DAVENPORT IA
52804-1844
US

IV. Provider business mailing address

PO BOX 4028
ROCK ISLAND IL
61204-4028
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4400
  • Fax: 563-421-4445
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number074065
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: